Perspective
A music intervention to reduce anxiety before vascular angiography procedures

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Patients scheduled for vascular angiography are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported mixed results for anxiety reduction techniques in other procedures settings, such as education, cognitive-behavioral skills, coping and relaxation skills, combinations of techniques, and music. Music as an intervention for pre-procedural anxiety prior to vascular angiography has not been studied. A randomized controlled trial of 170 patients was undertaken to determine whether 15 minutes of self-selected music reduced pre-procedure anxiety. The State Trait Anxiety Inventory was used to measure patients’ anxiety. One-hundred sixty-six men and 4 women comprised the sample with an average age of 66.8 years (SD 9.95, range 37 to 85 years). Patients who listened to music (n=89) reduced their anxiety score from 38.57 (SD 10.46) to 35.2 (SD 9.7), while those who did not listen to music (n=81) reduced their anxiety score from 36.23 (SD 10.54) to 35.1 (SD 10.59); the difference between the groups was statistically significant (t=1.95, df 161, p=0.05). Pulse achieved a statistically significant reduction in the music group (t=2.45, df 167, p=0.02). Music is a noninvasive nursing intervention that patients enjoy and reduces their anxiety and their pulse rate. Further research should address using music to reduce anxiety in other interventional vascular angiography settings with equal numbers of men and women and comparing self-selected versus investigator-selected music.

Section snippets

Theoretic approach

The current study is based on Spielberger’s construct of anxiety and the assumption that state anxiety can be reduced through a music intervention (Fig. 1). Anxiety, as defined by Spielberger, is an emotional state consisting of feelings of tension, apprehension, nervousness, and worry, with activation or arousal of the autonomic nervous system. Spielberger differentiates between two related components of anxiety: state anxiety and trait anxiety. State anxiety is a transitory emotional state

Literature review

The research literature includes studies about anxiety reduction through relaxation methods, some of which included music. Three studies examined anxiety reduction in cardiac catheterization. Anderson and Masur4 used audiovisual methods of education specific for cardiac catheterization, cognitive-behavioral skills training, coping and relaxation skills training, combinations of education and training, and a neutral video as a placebo (N = 60). They found that subjects who received active

Study aims

The study aim was to evaluate whether music reduced patients’ anxiety before their vascular angiography procedures. The research question was, “Will listening to music for 15 minutes before vascular angiography reduce patients’ anxiety?”

On the basis of past research suggesting physiologic changes are impacted from music, secondary analyses were computed to test the following: Will listening to music for 15 minutes before vascular angiography decrease patients’ blood pressure, pulse rate, or

Design

This study used a quasi-experimental design with randomization to experimental and control groups. Patients were assigned using a table of random numbers to either the music or control group. The patients and staff were not blinded to assignment.

Sample and setting

The study was conducted in the Interventional Radiology Department at an urban, West coast, university-affiliated Veterans Affairs Medical Center. The institutional review board approved the study, and all participants signed informed consents.

Patients

Results

A total of 190 persons were recruited, 20 refused, and 170 persons completed the study. The control group comprised 81 persons, and the experimental or music group comprised 89 persons. The average age was 66.8 years (SD 9.95, range 37-85 years). There were 166 men and 4 women. Baseline values are included in Table I.

Ninety-eight percent of participants stated they listen to music regularly, with 48% listening at home and 25% listening in more than one location (e.g., car, work, other).

Discussion

This is the first study to test a music intervention for anxiety reduction in patients undergoing vascular angiography. This investigation contributes new knowledge to the literature with significant findings in a large sample in a newly explored setting. Anxiety reduction with a music intervention was well established in research conducted between 1994 and 2004. In a recent review of 12 studies using music interventions, 10 used the STAI to measure anxiety and 9 reported a significant decrease

Limitations

Study limitations included length of time for music intervention and participant gender. In a rapidly paced clinical environment, a 15-minute intervention was the most practical and effectively reduced anxiety in our prior study in the GI Department. Other studies report music interventions between 15 and 40 minutes with varying degrees of effect on anxiety.13 Although listening to music more than 15 minutes may have reduced anxiety further, the delay in the procedure may have provoked more

Implications for practice and research

Findings from this study add to the body of literature that music reduces anxiety and heart rate before invasive procedures. Our study supported the proposed model using Spielberger’s theory that an increased state anxiety can be decreased with self-selected music. This finding fits with the theory that state anxiety can be modified and is transient, related to the situation. The group who did not listen to music had insignificantly lower anxiety scores than the music group at baseline. Of note

Acknowledgments

We thank the nursing staff of the Interventional Radiology Department of the VA Medical Center, San Francisco, for their dedication to this study: Judy Lawing, BSN, RN; Lucinda Swendsen, RN; Linda Naugle-Cetta, BSN, RN; and Gail Clarke, RN.

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The study was funded by the Society for Vascular Nursing.

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